采用固体试验餐的高分辨率测压对有临床相关症状的食管动力障碍的诊断效果：系列诊断研究。
Diagnostic yield of high-resolution manometry with a solid test meal for clinically relevant, symptomatic oesophageal motility disorders: serial diagnostic study.
机构信息
Clinic of Gastroenterology & Hepatology, University Hospital Zürich, Zürich, Switzerland; Department of Gastroenterology & Hepatology, Changi General Hospital, Singapore.
Clinic of Gastroenterology & Hepatology, University Hospital Zürich, Zürich, Switzerland.
出版信息
Lancet Gastroenterol Hepatol. 2017 Sep;2(9):654-661. doi: 10.1016/S2468-1253(17)30148-6. Epub 2017 Jul 3.
BACKGROUND
The use of high-resolution manometry (HRM) to diagnose oesophageal motility disorders is based on ten single water swallows (SWS); however, this approach might not be representative of oesophageal function during the ingestion of normal food. We tested whether inclusion of a standardised solid test meal (STM) to HRM studies increases test sensitivity for major motility disorders. Additionally, we assessed the frequency and cause of patient symptoms during STM.
METHODS
Consecutive patients who were referred for investigation of oesophageal symptoms were recruited at Nottingham University Hospitals (Nottingham, UK) in the development study and at University Hospital Zürich (Zürich, Switzerland) in the validation study. HRM was done in the upright, seated position with a solid-state assembly. During HRM, patients ingested ten SWS, followed by a standardised 200 g STM. Diagnosis of oesophageal motility disorders was based on the Chicago Classification validated for SWS (CCv3) and with STM (CC-S), respectively. These studies are registered with ClinicalTrials.gov, numbers NCT02407938 and NCT02397616.
FINDINGS
The development cohort included 750 patients of whom 360 (48%) had dysphagia and 390 (52%) had reflux or other symptoms. The validation cohort consisted of 221 patients, including 98 (44%) with dysphagia and 123 (56%) with reflux symptoms. More patients were diagnosed with a major motility disorder by use of an STM than with SWS in the development set (321 [43%] patients diagnosed via STM vs 163 [22%] via SWS; p<0·0001) and validation set (73 [33%] vs 49 [22%]; p=0·014). The increase was most evident in patients with dysphagia (241 [67%] of 360 patients on STM vs 125 [35%] patients on SWS in the development set, p<0·0001), but was also present in those referred with reflux symptoms (64 [19%] of 329 patients vs 32 [10%] patients in the development set, p=0·00060). Reproduction of symptoms was reported by nine (1%) of 750 patients during SWS and 461 (61%) during STM (p<0·0001). 265 (83%) of 321 patients with major motility disorders and 107 (70%) of 152 patients with minor motility disorders reported symptoms during the STM (p=0·0038), compared with 89 (32%) of 277 patients with normal motility as defined with CC-S (p<0·0001).
INTERPRETATION
The diagnostic sensitivity of HRM for major motility disorders is increased with use of the STM compared with SWS, especially in patients with dysphagia. Observations made during STM can establish motility disorders as the cause of oesophageal symptoms.
FUNDING
None.
背景
使用高分辨率测压（HRM）诊断食管运动障碍是基于十次单水吞咽（SWS）；然而，这种方法可能不能代表正常进食时的食管功能。我们测试了在 HRM 研究中加入标准化固体测试餐（STM）是否会提高主要运动障碍的检测敏感性。此外，我们还评估了患者在 STM 期间症状的发生频率和原因。
方法
连续招募因食管症状就诊于英国诺丁汉大学医院（英国诺丁汉）的发展研究和瑞士苏黎世大学医院（瑞士苏黎世）的验证研究的患者。HRM 在直立、坐姿位置进行，采用固态组件。在 HRM 期间，患者先吞咽十次 SWS，然后再吞咽标准的 200 克 STM。食管运动障碍的诊断基于分别针对 SWS（CCv3）和 STM（CC-S）验证的芝加哥分类。这些研究在 ClinicalTrials.gov 上注册，编号为 NCT02407938 和 NCT02397616。
结果
发展队列纳入了 750 例患者，其中 360 例（48%）有吞咽困难，390 例（52%）有反流或其他症状。验证队列包括 221 例患者，其中 98 例（44%）有吞咽困难，123 例（56%）有反流症状。在发展队列中，使用 STM 比 SWS 诊断出更多的主要运动障碍患者（321 例[43%]通过 STM 诊断 vs 163 例[22%]通过 SWS 诊断；p<0·0001）和验证队列（73 例[33%] vs 49 例[22%]；p=0·014）。这种增加在吞咽困难患者中最为明显（360 例患者中有 241 例[67%]在 STM 下诊断，而 SWS 下只有 125 例[35%]患者，p<0·0001），但在因反流症状就诊的患者中也存在（329 例患者中有 64 例[19%] vs 发展队列中的 32 例[10%]，p=0·00060）。750 例患者中有 9 例（1%）在 SWS 期间和 461 例（61%）在 STM 期间报告了症状（p<0·0001）。在 321 例有主要运动障碍的患者中，有 265 例（83%）和在 152 例有次要运动障碍的患者中有 107 例（70%）在 STM 期间报告了症状（p=0·0038），而在 CC-S 定义的运动正常的 277 例患者中只有 89 例（32%）（p<0·0001）。
结论
与 SWS 相比，使用 STM 可提高 HRM 对主要运动障碍的诊断敏感性，尤其是在有吞咽困难的患者中。在 STM 期间的观察结果可以将运动障碍确立为食管症状的原因。
资金
无。
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